Need advice to manage a CMPI and a milk ladder introduction

[Eyelet]

I have two children, this is about both of them so please be patient with me, DD1 - now just about to turn 4 and DD2 just turned 1 - I've put my questions into italics so as to try to make it easier for people to help.

DD1
NICU baby tube fed from birth until a few weeks old, combine fed until 5 weeks but we quickly realised that she was CMPI and I cut all milk and soya from my diet, she was FTT and we struggled to wean her onto foods with colic and reflux. General support from dieticians was poor but we got there eventually. There were three causes - either her digestive tract was damaged due to the problems she had at birth, or the gut was affected by the high level doses of ABs in NICU or she had inherited a mild CMPI from me.

Tried reintroducing cooked dairy a few times but all resulted in tummy issues (diarrhoea) and massive skin flare ups to the point the GP was prescribing every ointment until the sun and strong steroids. A fortnight ago she accidentally ingested butter and we saw no ill effects so a few days ago we started the milk ladder with half a malted milk biscuit (now Day2).

Has anyone used the milk ladder for reintroducing dairy and how long did it take them? We suspect DD1 won't ever be able to tolerate cheese but being able to give her good fats from dairy and also more calcium is our main aim and to reduce her sensitivity before she starts school.

DD2
We were wary when she was born and also started with colic about my intake of dairy and so I cut out cheese and chocolate and had only milk in hot drinks, she seemed less sensitive than DD1 but we were cautious upon weaning at 6 months. We discovered yoghurt made her sick (reflux worsened) although nursery had given her cooked milk in custard and we think it only causes mild discomfort. We were advised to start her on a similar milk ladder process and she also had half a malted milk biscuit yesterday. Last night she was clearly in a great deal of pain, writhing, screaming awake every 45minutes and miserable. This morning DH found traces of blood in her stools.

I am holding off any further milk introduction - should I absolutely ban all dairy including the trace amounts she has at nursery or should we start with a different dairy source?

For your second question: yes, completely take her off any dairy at all. she is not ready yet. Try after six months again with half a biscuit. My DD has the same initial symptoms of being in pain and crying,

Also, have your children been seen by an allergy pediatrician?

I went to a talk by Dr Adam Fox (you can google him, he is a leading allergy pediatrician in the UK), and he said that there is evidence that probiotics may help reduce allergic reactions, though the evidence is not concrete, and further research and trials are currently being done. However, he said that he would give it to his allergic child, as it definitely doesn't do any harm. I was very skeptical about probiotics but have changed my mind now.

Also get your children's vitamin D levels checked too, as there appears to be a link between low vitamin D and allergies too.

Sorry I can't help with your 1st question. My DD isn't ready yet to start on the milk ladder, so we are waiting.

Where odd you get the milk ladder from btw? Was it from the journal article? If so I think there are details there or in the NICE guidelines about how you should do it.

If I recall correctly you give the biscuit for 5 days before being sure that there is no reaction to that. And then the next week you move up. But don't quote me on it.

DD1 has been seen by an allergist (although it was a dietician not a paed) however she is under paed care and will be for some time to come. DD2 we have pretty much been told to just get on with it and do as we think best.

Milk Ladder came from a friend - its a PDF.

Is it this milk ladder?

ifan.ie/wp-content/uploads/2014/02/Milk-Ladder-2013-MAP.pdf

Bearing in mind her reaction, I would ask for a referral. At least she can have the skin prick test and rule out other allergies.

We see GP for MMR next week so I'll mention it then, she has been very unsettled today. DD1 has awful wind (which she thinks is hilarious) but is not complaining of any problems, we're keeping a close eye on her skin.

We introduced dairy to cmpi ds at 1y9m on the advice of an nhs allergy specialist consultant, we did a gf egg free version of the ladder with foods that suited the other issues rather than the usual. It look around 6m to get him on to normal milk and a further 3 or so before we stopped tracking the amounts of dairy he consumed and let nursery give him anything. Mostly us getting use to it and being careful than him though! The consultant gave frustratingly little info, thank god for mumsnet! We treated soya products as a completely separate issue and introduced that in stages too after the dairy.

Dd is 13m and while she didn't have gluten and egg problems her reflux was worse and not helped by dysphasia and a hiatus hernia. She can tolerate some butter and cheese and a little soya and has had more challenges than ds, pretty much monthly as she gets hold of something she shouldn't (thank you ds feeding her your yoghurt!). I hope that she will go on to normal milk one day but I am easier with it this time round because I know enough tasty df recipes and she is coming out of it quicker than ds. When she has too much dairy she dribbles vomit constantly for a day or so, I have an intuition of how much she has had to keep her well under that level now.

The above isn't very helpful but I would say that the consultant was very concerned that ds hadn't had any trace dairy because she believed that gave him a higher risk of developing an allergy to dairy. Not everyone agrees but it is worth taking professional advice on the topic, I was certainly happier after a series of scratch tests. I would keep the trace stuff personally.

Also, the ladder link above is slightly differed to the order recommended to us. We did cheese before yoghurt and milk was powdered formula, pasteurised cows milk then fresh cows milk. Apparently there is a big difference between the milks. Cream was last, so we treated that as including fresh custard, icecream etc.

If she has reacted to milk in baked books, it is very very unlikely that she is just having mild symptoms with custard at nursery. Custard doesn't just have traces of milk, unless of course it was made with non dairy milk.

Btw have you looked into A2 milk? You could try that with your DD1

A2?

Well it did seem an excessive reaction given she had been eating custard at nursery. Because I've effectively been df and sf for four years now between breastfeeding two dc then I can tolerate a little yoghurt or cheese but cannot eat icecream without an immediate reaction - whoch bwars out the way you do it veronica

We don't have a specialist allergen paed here, some kf the advice is decidedly old and so for now given dd2 is still breastfed I'll concentrate on dd1 and getting her more used to dairy.

theres a chance dd2 did have nondairy custard as they often make oat milk custard but she did have grumbles that night. Nothing compared to last night though - teething wouldn't cause that level of reaction would it? We've four molars cutting through and so she has been having ibuprofen.

Teething is a difficult one. You could retry once more after her teething is over if you are not sure?

Consultant did say that when a child is ill their threshold of tolerance to an allergen lowers.

www.a2milk.co.uk

Dd2 still miserable but no sign of skin problems or worse tummy ache, she is feeding non stop but I'm convinced that the culprit is teeth. For now though we wait another six months to trial dairy or soya.

dd1 no sign of tummy ache or issues but she has started to scratch - it has been hot though so do I continue or not?

As she is older, and can tell you about her symptoms, I probably would. It's so difficult to decide what to do, I know, I've been there. I find myself constantly doubting the decisions and the symptoms

We were told to carry on each stage for a minimum of 2 weeks, to go quicker if we were confident (I'm a natural pessimist, never was and took about a month on the first one before going to the next!), never to stop a stage before 2 weeks just encase it was clouded by a teething/bug/cold/tiring day even making them grumpy anyway. I would carry on the stage but not escalate.

Reactions to dairy for both were always made far worse by colds, vaccinations, teething, stressful/tiring weekends away.